PB2361: DIFFUSE LARGE B-CELL LYMPHOMA IN THE ELDERLY: RETROSPECTIVE ANALYSIS FROM A SINGLE CANCER CENTER IN ALGIERS
Authors: Talbi Faiza, Sahraoui Leila, Abbadi Mohamed Rafik, Otsmane Hakim, Belakehal Salah, Bachiri Aissa
Journal: HemaSphere (2023)

Topic: 19. Aggressive Non-Hodgkin lymphoma - Clinical Background: Despite improvements in outcome using chemoimmunotherapy, treating elderly patients with diffuse large B cell lymphoma (DLBCL) remains challenging. Reliable risk stratification beyond age is lacking and consequently elderly patients are often treated with reduced-dose therapeutic regimen with palliative intent. Aims: We retrospectively analyzed outcomes of DLBCL patients aged 60 and older treated at military hospital of Algiers Methods: In this retrospective study, 1we included patients aged ≥ 60 years, newly diagnosed with DLBCL 1according to WHO classification between January 2016 and Dec 2021 at our center. Demography, clinical features, associated co-morbidities, and first line treatment outcomes were analysed. Patients were followed up till January 2022 Results: One hundred thirty two lymphomas (>18 years) were evaluated, of which 51 (39%) patients were ≥60 years, they received first line treatment for DLBCL. Median age was 73 years (range: 60–90), 12 pts (24%) were age 80 years or older, gender ratio was 1.04. 27% patients presented with early-stage disease, 32% with low and low-intermediate International prognostic index, 61% with nodal disease. Two or more co-morbidities were present in 43%. The commonest extra nodal site was gastro-intestinal (20%).There were no differences in IPI (p=0,33), stage (p=0.32), B-symtoms (p=0.76), number of extranodal lesions (p=0,13), maximum tumor diameter (p=0,06) between patients aged under versus ≥ 80y. Chemotherapy regimens received included 1R-CHOP (n= 32 for patients aged <80 y vs n=2 ≥ for those older then 79 years), split R-CHOP” regimen (n=1/ n=8 respectively for patients aged <80 y vs n≥ 80 years), and R-COP for anthracycline-ineligible or elderly frail patients (n=3/n=3 respectively for aged <80 y vs n≥ 80 years), p=0.000 (s).The decision to use anthracycline or non-anthracycline 1based regimen 1was at the discretion of the physician depending 1on the performance status and frailty. Primary G-CSF prophylaxis was used in all patients. 1After 4 cycles of chemotherapy, patients 1underwent an interim PET-CT for response evaluation. Patients who attained partial response underwent a 1repeat PET-CT evaluation at the end of 6 cycles. 1Post treatment completion, patients were f1ollowed up for clinical examination every three months for the first two years, six monthly for the next three years and annually thereafter. 1Out of 44 evaluable patients, the complete remission (CR) rate was 53%. For patients between 60 to 80 years of age and deemed fit for standard chemotherapy (RCHOP), CR rate was 50%. Among patients over 80 and deemed fit for standard chemotherapy, the CR rate was 100% (n=2/2). Frail patients treated with the “split R-CHOP regimen” (n=8) had a CR rate of 25% with 50% (n=4) partiel response (p=0.58).For all patients, the 1median progression-free survival (PFS) was 28 months with a median overall survival (OS) of 25 months. The median PFS for pts between 60 and 80 years of age treated with standard chemotherapy was 27 months. Median PFS in pts >80 years of age treated with standard chemotherapy was 23 months, whereas median PFS in frail pts treated with “split R-CHOP regimen” was 15 months, p=0.25 (ns) Summary/Conclusion: Our data reveal interesting 1findings about elderly pts treated for DLBCL. PFS and OS in general are poor as has been reported by others. elderly deemed more robust who were treated with standard dose RCHOP-21. Though limited gby small numbers, our institutional data suggest 1that frail patients can tolerate a modified R-CHOP regimen although 1survival remains short. Keywords: Lymphoma therapy, Lymphoid malignancy, Diffuse large B cell lymphoma, Lymphoproliferative disorder